HIM Domain 3
Domain 3 Guided Notes
What makes up the HC Delivery System?
Education/_Research_____________ - med schools, professional associations, nursing education_______
Suppliers - Big Pharma, _____Biotech______ companies
Insurers - BCBS, ___Medicare______, Medicaid, Managed Care, _____VA__________, Tricare
Providers - Primary Care Docs, ___HMOs,___________, Specialists, Hospitals
Payers - BCBS, State Agencies, ____Commercial ___________ Insurers (Aetna, Kaiser)
Government - _____Research Funding________, Public Health, Health Policy
Where will YOU fit in as a Certified CMAA?
You will be submitting _____claims__________ to payers on behalf of the provider
You will be acting upon requests for ______PHI_________
You will be scheduling appointments for new and existing _____________ patients
You will be collecting payments from patients (______co_________-_____pays__________
You will be ensuring all patients have signed the _____NPP__________ (Notice of Privacy Practices)
You could potentially be answering questions from patients regarding their _____EOB__________ (Explanation of Benefits)
6 Dimensions of Healthcare Quality
Safety
Timeliness & ___Accesebility____________
Equity
______Effectiveness_________ & Appropriateness
PT ___Centered____________ Care
Equity
Common Quality Indicators in Healthcare - Primarily Inpatient
Number Of Medication___________ Errors - The frequency of errors when prescribing medication. A high number could indicate a problem with the facility’s prescription ordering system.
Complication Rate - The percentage of patients who develop ___complications____________ (typically surgical complications) as a result of care. It can be tracked by a specific timeframe or division. A high rate of complications is common for hospitals that regularly perform __________high_____-_____risk__________ procedures; or it can indicate a low quality of care.
Percentage Leaving Against Medical Advice - ____AMA___________ - The number of patients who check out of the hospital ____against___________ the advice of doctors, divided by the total number of patients served. A _____high__________ percentage may mean the facility isn’t ______adequately________ serving patients who need ______treatment_________, a situation that can lead to ____high readmission rates___________ or public safety issues.
Post-Procedure Death Rate - The number of deaths___________ that occur after ____treatment___________. There are expected death rates (low to high percentages) for each procedure. For accuracy, the post-procedure death rate measurement must factor the ________risk level_______ level into calculations. Track it hospital-wide, as well as for specific divisions and surgical teams.
____Readmission___________ Rate - The percentage of patients _______________ divided by the total number of patients _______________ during a specific time period. A ______high \_____ percentage could indicate ____care___________ is ______low_________ quality and ____ineffective___________.
Hospital ____Acquired___________ Conditions _______________ - The number of new conditions patients contracted ____during___________ their ____hospital stay. HACs can be anything that are a direct result of receiving healthcare, ranging from _allergic ______ reactions to medication or pressure ______ulcers_________ (bed sores).
Average ____Minutes____ Per Surgery - The time to complete a ____surgical___________ procedure. This measure is usually segmented by type of _____surgery__________ and references standard deviations. High___________ variations in time or abnormally _____long__________ surgeries may indicate the surgical ___process____________ isn’t structured in an efficient or ______methodical_________manner, which can lead to a ____decrease___________ in _____quality__________.
Average ____Length___________ Of Stay _______________ - The total time it takes for patients to be _____admitted__________, treated, and ______discharged_________. If this number is low and other effectiveness measures are positive___________, this could indicate a highly ___efficient____________ facility.
Overall Patient Satisfaction - ___Patients____________’ perception of their _______quality________ of care. Typically, hospitals collect feedback by mailing and emailing surveys to previous patients. ___Low____________ satisfaction can signal a ____problem___________ with hospital _____ operations_________ or care quality, but __________high_____ scores are often used as marketing tools_____ to ______promote_________ the hospital and attract donors.
Hours Of Valuable Employee Training - CEUs___________
The number of _____training __________ hours and corresponding employee _____evaluations__________ of training. If training hours are high and hospital employees find those training to be helpful, then patient care and quality will likely be better.
Patient-To-_______Staff________ Ratio -
Number Of Referrals - The number of ______patients_________ referred to another ___facility____________. If referrals are high, it may indicate ____patient needs______ aren’t being ______met_________, or it could simply serve to track the volume of patients being sent to more specialized facilities.
Doctor-Patient Communication Frequency - How frequent and ____seamlessly___________ doctors, patients, and proceduralists ____communicate.___________. Even when controlling for treatment types, this can be difficult to accurately ___measure.____________. Yet establishing general ___benchmarks____________ can provide insight into whether patient needs are being considered.
Number Of Patient Complaints - The amount of complaints submitted by ____patients___________ regarding the care they ___received.____________. These complaints could be submitted in the midst of care or _____post__________-treatment.
Patient Wait Times By Process Step: This measure is broken down into sub-measures that track the timeliness of a hospital’s primary process steps. For example:
Arrival to ______bed_________: How long a patient waits after being checked in to be placed in a bed.
Arrival to nurse or ___physician____________: How long a patient waits after being checked in to see a provider.
Arrival to _______discharge________: How long it takes for a patient to be discharged after check in.
There is a ____hronological flow_______ to this measure, and results provide insight not only into quality of care but also patient _____satisfaction__________ rates.
Occupancy Rate - The number of _______rooms________ filled with ___patients____________ divided by the total number of ____rooms___________ in the _____hospital__________. Some hospitals have a greater capacity for being over-occupied and can use other departments and hospital beds, but others are small and lack those resources. If a facility’s occupancy rate is too _______high________ for its size, then ____resources___________ are likely spread _____thin__________ and the ___quality____________ of service could drop.
COMPLIANCE consists of several terms!
Laws - obligation imposed by the authority to ____protect___________ pts, providers, property. Non-compliance may lead to punishment_____________! Example - ___FDA____________
Regulations - Rules/orders issued by an executive ____authority___________ or _____regulatory__________agency of the govt with the force of law. Healthcare Quality Improvement Act (_____HCQIA__________) - provides immunity to medical providers who do peer reviews to investigate potential ______fraud_________ & ____abuse___________.
Guidelines- written recommendations of ________policy._______. Example - coding guidelines
_______Policies________ - written documents that specify ___responsibilities___________ among boards, mgt, medical staff. Example - health & safety policies to define how health care _______services________ are provided.___
____Standards___________ - Criteria & practices established by ___authority____________ as rules for ____measuring___________ value, extent or quality. Example - ethical standards
Basic Medical Law
Medical Law - ____Laws___________ rights & responsibilities of medical providers & pts
medical providers & pts
Contracts - Legally _______binding________ agreements between ____parties___________
Malpractice - Any TX by a medical professional that does ____not___________ follow the ____standards___________ of care
Negligence - When a pt does ________not_______ receive _____adequate__________ & appropriate ___care____________, which leads to ____suffering___________ & harm
Pt. Abandonment -Form of malpractice that occurs when a provider stops treating a pt without a reasonable cause and/or without reasonable notice. Should be provided in ____writing___________ by ______certified_________ mail w/ return receipt
YOU as a CMAA are a ___mandated____________ reporter!
Reporting abuse (elder, child) and communicable diseases & ADAAA discrimination
Quality in Healthcare
The US spends 18% of its Gross Domestic Product (GDP) on healthcare, yet, by some measures, it is the least healthy of all of its peers.
Approximately $1 trillion is thought to be ____wasteful___________ spending and 14% of that ($140 billion) is due to _______clinical waste_________.
Healthcare organizations can change this wasteful trajectory by incorporating Quality Improvement (QI) methods to improve processes.
______Risk_________ Management is a typical department in an ___inpatient____________ facility
RM is usually housed under _____HIM__________
RM Officer can either be an ___HIM____________ professional or a ______BSN_________
In healthcare risk management, safety__________trumps _____finances__________
While a successful healthcare risk management strategy is likely to improve costs and efficiency for individual healthcare organizations, more importantly, it can help to save lives and improve the experience for patients, caretakers and the overall healthcare system.
Healthcare risk management comprises the systems and processes employed to ___uncover____________, ____mitigate___________, and ____prevent___________ risks in healthcare institutions for staff, patients, and visitors. Understand its purpose, elements, the risk manager’s role, and more.
Compliance
Follow Health Insurance Portability & Accountability Act (___HIPAA____________) Guidelines
Ensure patient’s ______privacy_________ and ____security___________ of PHI
Ensure charts are properly secured___________ (displayed with PHI covered)
Use a HIPAA___________-______compliant_________ sign-in sheet
Knowledge of what information is NOT___________ private for authorities & health departments
Child ____abuse___________, STDs/STIs, gunshot wounds, HIV___________
Knowledge of ____ROI___________ forms
Knowledge of who can access patient’s chart
Proper use of ___passwords____________
Knowledge of peer-to-peer ___information___________
Follow HIPAA guidelines for ____covered___________ and _____non-covered__________-covered entities
Knowledge of appropriate discussion of medical information (_____when__________) and ___where____________)
Knowledge of proper _____verification__________ of medical ____information___________ (what to release and what not to release when verifying information)
Knowledge of ________penalties_______ for ____violating___________ HIPAA practices
Document release of information (when and to whom information can be released) _____Accountability__________ of ____Disclosures___________
Knowledge of PHI Standards
Office of Civil Rights (____OCR___________) under Dept of Health and Human Services (___________HHS____) oversees compliance
Follow Occupational Safety & Health Administration (OSHA) Guidelines
Adhere to OSHA guidelines
Knowledge of _____SDS__________
Knowledge of how to report an OSHA incident
Knowledge of the ____evacuation___________ plans and ______emergency_________ procedures
Follow Center for Medicare/Medicaid Services (_____CMS__________)
Report Medicare/Medicaid ____fraud___________
Awareness of consequences of fraud
Knowledge of the difference between Medicare and Medicaid
Recognize the _____CMS__________-______1500_________ form - ____outpatient___________ services
Recognize the _____UB__________-_______04________ - ___inpatient____________ services
The Joint Commission (________TJC_______)
Seeks to improve health care for the public, in collaboration with stakeholders, by evaluating health care organizations
_______Voluntary________ - $$
If choose NOT to become TJC accredited, will affect _________billing______ of services
National Patient Safety Goals (_____NPSG__________)
Aims to improve patient safety
Created by TJC - re evaluated ____every___________ year
YOU, the CMAA, play a significant role in data collection for pt errors
Office of _____Inspector__________ General (OIG)
Investigates all fraud___________ & _______abuse________cases suspected or reported for _________federally______ funded medical programs
Americans with _____disibalities__________ Act Amendments Act (ADAAA)- 2008
Ensures policies and practices that define disability, with the aim of _____protecting__________ people who have disabilities from discrimination
What is the NPP? _______notice________ of ____privacy___________Practices
What must the document include?
How PHI is used and disclosed by the facility- ____TPO___________ (TX, Payment, Healthcare Operations)
The duties of the provider in protecting health information
The ________patinets_______ rights regarding _____PHI__________
How complaints can be filed if patients believe their privacy has been violated
Whom to contact at the facility for more information
The ________effective_______ date of the NPP
Knowledge of peer-to-peer information
Peer to peer file-sharing allows _____computers__________ to ______download_________ files and make them (108) to other people on the network.
What are the risks?
HITECH (Health ______information_________ Technology for ____economic___________ and Clinical _______health________ Act sets requirements for increased _____protection__________.
The added security makes PHI unusable, _____unreadable__________, or _____un decipherable__________ to unauthorized individuals.
Who needs to be notified if a breach occurs?
Patients, federal___________ ___goverment____________, Media
HIE (Health Information ______Exchange_________) - enables the sharing of health-related information among ______providers_________according to nationally recognized standards.
Compliance
What are Covered ____Entities___________ (CE)?
Providers, hospitals, laboratories, facilities, nursing homes, rehab facilities, health plans, health care clearinghouses, and those that supply care, services, or supplies to a patient and ____transmit___________ any health information ______electornically_________.
What are NON-____covered___________ Entities?
Organizations that use, collect, access, and disclose individually identifiable health information, but ________do_______ _____not__________ transmit ______electronic_________ data. These DO NOT have to comply with the Privacy Rule. They do not ____bill___________, receive ______payment_________, or provide healthcare ____services___________ (______fitbit_________, life insurance companies, school clinics)
Do _______________ _______________ (BAs) have to comply with HIPAA?
Yes! Remember: The minimum necessary_____ standard - - PHI should not be used or disclosed when it is not necessary to satisfy a particular _________purpose______ or carry out a ____function___________.
What do _____PHI__________ Standards relate to?
Standardized electronic formats when sending _______adminstrative________ and _______finacnial ________ data. This is called electronic data interchange (EDI).
Refers to the ____exchange___________ of routine ____business___________ transactions from one ___computer____________ formats are required.
The standards were recently revised to accommodate _______ICD_______-10-CM - called ASC X12 Version 5020 standards.
Compliance
NPI - National ________provider_______ Identifier
Unique 10___________-digit code for providers required by HIPAA
This code keeps any information about the provider (____loction___________ & ___specialalization____________) confidential.
OSHA - Occupational _______Safety________ & Health _____Administration__________
Part of the U.S. Department of ____labor___________ with the mission to ensure workplace ________safety_______ and a healthy working environment.
Originally focused on ____construction___________ workers & engineers but ____HIV___________put focus on healthcare and the ____risks___________ resulting in:
Bloodborne ____patogens___________ Standard
__________General _________Duty______ ___Clause____________ - states that every workplace must be free of any hazard that might cause serious harm or death.
______Needlestick_________ Safety & _____Prevention__________ Act - requiring procedures for the safe use of ______sharps_________ & providing urgent care & TX for those exposed to ______bloodborne_________ ____pathogens___________.
OSHA Requirements
_____SDS__________ - Safety Data Sheet
Without SDS for those exempt, too difficult to determine what type of health, reactivity, ________flamability_______, or other risks the chemical could have.
THEREFORE - keeping SDS records on ALL _____chemicals__________ is _______required________.
Emergency Preparedness
Every medical facility with more than _____10__________ employees must have a written emergency plan in place.
The plan must include the following:
Reporting fire or other ____emergencys___________
Performing an emergency evacuation___________, including the type of evacuation and ___________exit____ ___route____________ assignments
Establishing rules for ___employees____________ who remain to run critical equipment before they evacuate
_________Accounting______ for all employees after evacuation
Establishing ____Rules___________ to be followed by employees performing rescue or medical duties
Providing the name or title of the person (or persons) to be contacted about the plan or an explanation of the individual’s ____duties___________ under the plan___________
Must have a documented ___fire____________ prevention plan that includes:
A list of all major ___________fire____ hazards with the proper _______handling________ and __________storage_____ of each
The type of fire prevention _____equipment__________ necessary to control___________ each major hazard
Procedures to control accumulations of ____flamabble___________ and ___combustible____________ materials
The name or __________job_____ _____title__________ of the person responsible for maintaining equipment, preventing or controlling sources of ignition or fires, and controlling fuel source hazards.
Employees must be ___informed____________ of any fire hazards associated with their job.
Procedures need to be in place for natural ____disatsees___________ (tornado/hurricane), criminal incidents (robbery/vandalism), and large-scale events (terrorist attack/bioterrorism).
Evacuation Plan
________Safetu_______ Officer MUST give the ____order___________ to evacuate
Keep lights on when exiting the building
Use the 1st exit route. If it becomes impossible, use the ________1st_______ route
_________medicare ______ Fraud - making _____false__________ statements of ______represnetations_________ of material facts to obtain some benefit or payment for which no entitlement would otherwise exist.
Medicare Abuse - Any practice that may result in ____unnecessry___________ costs to Medicare
Compliance - Laws Specific to Medicare Fraud & Abuse
False ____Claims___________ Act (FCA) - Billing for medical services ___not____________ provided
Anti-______Kickback_________ Statute (AKS) - Medical providers financially ___benefitting____________ from referrals
Physician Self-____referral ___________ Law (Stark Law) - Prohibits referral to health care services that the provider (or for family members) has a ___financial____________ ____interest___________ unless an exception applies.
_____Social__________ Security Act - Payment & insurance for ___older____________ retirees & individuals with _______disabilities________
United _____States__________ Criminal Code - Protection with public ____behavior___________
________Suprise_______ Act - Protection from unknown medical ________bills_______
Compliance - Medicare Fraud - Coding
Fraud - making ______false_________ statements of representations of material facts to obtain some _____benefit__________ or ________payment_______ for which ______no_________ entitlement would otherwise exist.
________upcodinf_______ - assigning a diagnosis or procedure code at a ______higher_________ level than the documentation supports, such as coding bronchitis as ______pneumonia_________.
Unbundling - Using _____mutiple__________ codes that describe different components of a treatment instead of using a ______single_________ code that describes all steps of the procedure.
Program Abuse - Practices that either directly or indirectly result in ___unnecscary____________ costs to ______goverment_________-funded programs.
Conducting internal___________audits is one way to identify ____fraud___________ or __________abuse_____ within your organization.
Reporting Fraud - HIPAA includes regulations related to fraud & abuse.
Key areas: _____medical__________ necessity, upcoding, unbundling, billing for services ______not_________ provided
All fraud & abuse allegations MUST be compiled into a data bank, National Healthcare Integrity and Protection Data Bank (HIPDB).
ONLY ______federal_________ & _______state________government agencies are required to report such _______violations________
What to report?
Federal or state licensing & certification actions, INCLUDING:
_________Revocation______
Reprimands
Censures
Probation
suspensions___________
Any other ______loss_________ of license
AND/OR the right to apply for or renew a license . . . whether by VOLUNTARY surrender or non-renewability
Exclusion from participation in federal or state healthcare programs
Any other actions or decisions defined in the HIPDB regulations.
Back To HIPAA
HIPAA is a FEDERAL Law
Several Titles to the Law I, II, III, IV, V
Our Focus - Title ______II_______ - Prevents healthcare ___fraud____________ and _______abuse________, administrative simplification, and medical liability reform
Allows pts to access or request corrections to their PHI ****
___________privacy____ Rule (PHI) vs. ______Security_________Rule (EHR)
HIPAA Violation Tier Structure
Tier 1 - Unknowngly___________ committing a violation - min fine $____50,000___________per violation up to $_______________
Tier 2 - _____Reasonable__________ Cause - should have been aware but could not have avoided - min fine $_______1k________ per violation up to $50K
Tier 3 - ____Willful neglect___________ Neglect BUT an attempt has been made to _________correcr______ the violation - min fine $____50,___________ per violation up to $50K
Tier 4 - Willful Neglect where _______NO________ attempt has been made to correct the violation - min fine of $______50k_________per violation
MUST be disclosed if ever identified! Most likely to your Office Manager
Types of PHI - Protected Health Information
Personally _____Identifiable__________ information (PII) - ANY data associated with an ____individual___________
_________Individually______ identifiable health information (IIHI) - ___health____________ care data associated with an individual
TAKE NOTE - ___PHI____________ is ______IIHI_________that is used or transmitted by a CE
According to HIPAA, PHI includes 1 or more of the following identifiers . . . . . .
PHI
18 Identifiers
Name (Full or last & initial)
Vehicle Identifiers (including serial #s & license plate #s
All geographical identifiers smaller than a state, except for the INITIAL ___3____________digits of a zip code
________Device_______ identifiers & serial #s - implants
Phone #s
Web uniform resource locators (URLs)
Fax #s
Internet protocol (IP) address #s
______Email_________ addresses
Biometric identifiers - finger, retinal, voice prints
SS#s
Full ______face_________ photographic images & any comparable images
Medical Record #s
Account #s
Health insurance beneficiary #s
Any other ___unique____________ identifying #, characteristic, or code except the unique code assigned by the investigator to code the data
______certificate_________/license #s
When a CE (providers, health plans, clearinghouses) or BA (billing agencies, consultants, accountants) share PHI with other CEs, the following ____three___________criteria must be met:
Both CEs must have or have had a _______relationship________ with the ____pt________ (past or present)
PHI ______requested_________ must pertain to the relationship
Disclosing ONLY the ____minimum___________ _____necessary__________ information for health care
PERMITTED USE & DISCLOSURE OF PT. INFORMATION
HIPAA has placed exceptions for the good of the pt or population. The following PHI can be released without pt consent:
Reporting _____gunshot__________ or stab wounds
Reporting ___domestic____________ violence
Reporting child or elder abuse______________ or neglect
Identifying a suspect, ______fugitive_________, material witness, or missing person
Reporting STIS___________
Responding to a court order, warrant, _______subpoena________, or summons
_______HIV________/AIDS
Reporting specified _____communicable__________ diseases deemed public health concerns by a county or state
Chancroid
Other STDs/STIs are reported according to state & county regulations
________county_______
Syphilis
Procedures to Safeguard Data
________Cybersecurity_______ - important component of compliance with HIPAA regulations & security.
3 Types of Safeguards under HIPAA
____Adminsitrative ___________- creating a secure process for accessing PHI - policies/procedures
______Physical_________ - Screen visors
___technical____________ - Restricting data transfer, removal of PHI, password updates
AUDIT, AUDIT, AUDIT!!!
All employees MUST attend HIPAA training _____annually__________
Auditing is performed regularly - electronic ____footprint___________
What is the danger in sharing your password at work?
The audit report will indicate where the employees _______visited________ in the ____EHR___________.
Most employee access to PHI is
determined by _____job__________ _________description______.
Storage & Retention of Medical Records
___________retention____ laws include ____federal___________& ____state___________ - based on type of record
Facilities must follow these laws before implementing their retention policies & procedures, including how and where to store.
______EHRS_________ have revolutionized how pt records are stored and eventually ________destroyed_______
Releasing PHI in Accordance with HIPAA Privacy Rule & Facility
Remember the term interoperability _____________?
This concept allows organizations to share PHI across systems under HIPAA.
Pts must authorize the release of PHI prior to sharing with outside entities - i.e. Specialist.
HIPAA compliant ROI form must include:
Pt Name
Name of ______provider_________ or Organization to receive the PHI
_________Purpose______ of the disclosed Information
__________Siganture _____ of the pt or authorized representative AND DATE
___________Expiration____ Date of the authorization to ROI request
Releasing PHI in Accordance with HIPAA Privacy Rule & Facility
EXCEPTION - Pt. records related to ________reserach_______ & _______vaccinations ________. Many facilities obtain authorization to release PHI from the pt, such as retrieving past medical records or obtaining results.
YOU, as a CMAA, must know when authorization to release PHI is _____required__________ vs. ___________permitted____ uses & exceptions to the Privacy Rule
ADHERE TO PT’S BILL OF RIGHTS
Affordable ____care___________ Act (ACA) includes a Pt’s Bill of Rights that applies to those that have _____insurance__________coverage.
Focused on removing restrictions for pre-existing conditions, removing ___lifetime____________limitations, and ensuring a __________choice_____ of provider.
American Hospital Association (____AHA___________) also created a Pt’s Bill of Rights AKA as Patient ____care___________Partnership
Informs pt’s of their rights & responsibilities during hospital stays
Includes basic human ___dignities____________ expected for all pt _____encounters__________
Each set of rights include rules regarding cosent, the right to see a specialist, right to keep the same _______physician________, right to a second opinion, medical record ownership, right to _______refuse________ TX, and _______ADA________ compliance.
Laws that specify medical record ownership are regulated at the state level.
Most common - no law identified conferring specific ownership
If present - either hospital/physician owns the record, or patient owns the ___record____________(64) of the record.
Open ___Notes____________ is an initiative that encourages providers to allow pt access to their encounter notes.
Based on HIPAA that enables pts the right to review & request corrections to their record, providing a means to secure online access to the notes.
Patient Consent
Pt Consent - authorization given by a pt for medical TX
FOUR types of consent
____Expressed___________ - written or _______verbal________permission is granted by the pt
Implied - Pt ____cooperates___________ with medical care & TX w/o written consent
____Informed___________ - A ______thorough_________ process that explains the proposed pt TX, alternatives to TX, risks & benefits to accepting the TX, resulting in written consent
Waived - Informed consent is not ______obtained_________ from a pt because the pt is ______incapicitated_________ or unable to grant consent (criteria vary by state)
Proper reporting of errors/breaches in pt safety or pt care is considered an ______ethical_________ standard in medicine.
Your organization MUST have a designated _____privacy__________ ______officer_________ who oversees the policies & procedures regarding reporting of violations.
If the ____violation___________ is a breach, this would be considered a HIPAA violation.
Accidents in the workplace must also be reported to improve the _______safety________ of the environment for all employees.
_____Scope__________ of _____practice__________refers to a specific set of ______standards_________ that a medical professional may perform _______within_______ the _____limits__________of the medical license, registration and/or _______certification________.
Each __________state_____ has _____different__________ regulations re: scope of practice for medical professionals.
A _____significant__________ role in defining the CMAA scope of practice depends on factors such as:
Individual clinical/administrative performance competencies
Level of ___education____________ or training
Willingness of the employers to ________delegate_______ tasks
______maintaining_________current status for the license, registration, and/or certification
Professional Code of Ethics
Ethics - set of principles that ____differentiate___________ between ____right___________ and ____wrong___________.
Must be upheld on the professional AND ______personal_________ level - _____social__________ media_________ - BE CAREFUL!
Those that are non-compliant could result in legal action not limited to ______dismissal _________ and/or _____credential __________ ____removal___________.
_________NHA______ possesses a Code of Ethics that must be upheld by _____all__________ members.